Babies that Regurgitate, Vomit or have Reflux

Postnatal

Parents often wonder about their baby’s milk regurgitation and need reassurance. How can you tell the difference between regurgitation, vomiting, and reflux?

Regurgitation

Regurgitation is an overflow, a spontaneous return of undigested, odorless milk that usually comes up within an hour after feeding. Regurgitation is actually a normal physiological reflux in babies, related to the immaturity of the sphincter at the entrance to the stomach. According to the Canadian Paediatric Society, it has been established that at one month of age, 20% of healthy babies regurgitate or vomit after most feedings. These clinical symptoms increase to 41% in babies aged three to four months, but then decrease and become much rarer after the age of one.

This happens very often to babies who drink quickly, without pausing, or when they are moved after a feed, especially during the day when they are awake and very rarely at night when they are asleep. Gastric emptying (from the stomach) is slower in these babies, or delayed and influenced by diet (caloric density).

A diagnosis of regurgitation will be made when there is milk coming back up two or more times a day for at least three weeks or more. And all this without the presence of digested milk (vomiting), blood, or associated breathing difficulties (aspiration).

It should be noted that babies can regurgitate until the age of 12 months without any impact on their weight or development. Only time will improve the situation. There is no medication that can prevent regurgitation.

Vomiting

Vomiting, on the other hand, consists of the return of milk that has already begun to be digested. The milk that comes back up is curdled and therefore has a stronger odor. Projectile vomiting in very young babies is very common, occurring once or twice a day, due to the immaturity of the sphincter (the muscle at the entrance to the stomach). However, projectile vomiting after every feed is abnormal in a young baby and can cause dehydration, decreased urination, dry skin, irritability, and drowsiness. If you notice these symptoms, it is important to consult a healthcare professional quickly.

In the first year of life, it is not uncommon for babies to vomit, which is considered normal when related to solid foods and the introduction of different textures and pieces, but also during a cold, a prolonged period of fasting, a strong gag reflex, or developmental delay. Vomiting caused by crying due to discontent is not a health problem, but rather a situational issue.

We may therefore encounter vomiting of food (milk or other foods), bile (yellowish return when the child’s stomach is empty), or hemorrhagic vomiting, which contains blood and requires medical attention.

There are many causes of vomiting, depending on the age and general clinical picture of the baby. For a young baby, possible causes include intolerance, esophagitis (irritation due to acid reflux from the stomach to the esophagus), achalasia (difficulty with esophageal mobility in children), or other causes (infectious, metabolic, digestive, anatomical).

When to seek medical attention for vomiting: warning signs!

  • Lethargy and apathy, or, conversely, intense agitation.
  • The child is inconsolable and irritable.
  • The child has membranous spaces between the bones of the skull.
  • The child’s neck is stiff and they shy away from light: this may be a sign of meningitis.
  • Abdominal swelling.
  • Bloody or light green vomiting.
  • Blood in the stool.

Reflux

Reflux refers more to pathological, i.e., abnormal, regurgitation, which causes inflammation that can lead to tissue damage. When we talk about pathological regurgitation (reflux), the cause is also the relaxation of the lower esophageal sphincter (entrance to the stomach), but there is also a component related to slower and delayed gastric emptying. Reflux is observed in 5 to 9% of babies, often peaking around 4 months of age, then dissipating and fading away around 8 to 12 months.

Gastroesophageal reflux can be observed through a set of symptoms: the child swallows constantly after feeding; the child is seen swallowing, even if nothing comes out of their mouth. They are often uncomfortable when lying flat and cry more in the 2 hours after feeding, because rather than going to the intestine, their milk, mixed with an acidic digestive enzyme, rises from the stomach to the esophagus, which becomes irritated. The difference with vomiting is that reflux is more regular: it occurs almost every time the baby feeds. However, it is important to keep in mind that crying, agitation, and arching of the baby’s back, whether or not accompanied by regurgitation, may be normal behaviors or may be attributable to causes other than reflux.

Once again, time will allow the situation to improve. However, if the baby has reflux that impacts their growth or causes respiratory problems, a young baby. By modifying the practice somewhat, we cannot cure immaturity and reflux, but very often we can reduce discomfort and, in doing so, help the child sleep.

Furthermore, when examining family history, it is not uncommon to find that parents or grandparents are known to have and are being treated for reflux problems. However, this is not a hereditary problem, but rather a family tendency.

Reflux cannot begin at 6 months of age. If this seems to be happening, consult a doctor, as there may be another underlying cause.

How can you help relieve a baby who has reflux? Here are a few tips to help.

In summary

In most cases, if your child suffers from regurgitation, vomiting, or reflux, there is no cause for concern. If your baby’s weight is following their normal growth curve, it will not affect their development. In most cases, these situations are caused by the child’s immaturity, and only time will resolve the issue.

Consult a doctor in the event of:

  • weight loss and growth retardation,
  • if reflux begins after 6 months,
  • if reflux increases after 12 to 18 months,
  • if the baby vomits in a jet,
  • if the baby has bilious (yellowish) vomiting,
  • if there is diarrhea associated with reflux, with or without blood.

Some babies who grow more slowly than expected may be hospitalized for further investigation of their reflux. However, the latest data does not encourage diagnostic tests such as pH monitoring, impedance pH monitoring, or barium meals in babies. These tests therefore remain very limited in their use.

Marie Fortier
The baby expert

Article updated: April 2025.

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